Final Dissection Notecards Flashcards
What structures pass through the foramen magnum
Brainstem, vertebral arteries, cervical roots of the accessory nerves
Retropharyngeal space
Behind carotid sheath, medially meet posterior to the cervical viscera
Superior limit- basilar part of occipital bone
Superior thoracic aperture- inferiorly
Extends into the thorax
Anterior surface of the cervical vertebral column
Sympathetic trunk and the most cranial superior cervical ganglion (supplies head)
Superior to the superior cervical ganglion, the chain narrows again before entering the skull- internal carotid nerve
Prevertebral fascia and muscles
Lateral vertebral muscles
Longus colli and longus capitis- sympathetic trunk runs longitudinally on these
Anterior, middle and posterior scalene muscles
What connects the sympathetic ganglia with the ventral rami of cervical spinal nerves
Gray rami communicates
Vertebral artery route
Into the transverse foramen of vertebra C6 and observe where it emerges from the transverse foramen of atlas (C1)
The airway crosses the digestive tract in the
Tract
Pharynx
Extends from the base of the skull to the inferior border of the cricoid cartilage (C6 level)
The pharyngeal wall consists of 3 layers (from outside to inside)
Buccopharyngeal fascia- the adventitia of the pharynx that is continuous with the connective tissue that covers the buccinator muscle
Muscular layer- composed of an outer circular part and an inner longitudinal part
Mucous membrane
Inferior pharyngeal constrictor muscle
Anterior attachments are the oblique line of the thyroid cartilage and lateral surface of the cricoid cartilage. The posterior attachment of the inferior pharyngeal constrictor muscle is the pharyngeal raphe
Middle pharyngeal constrictor muscle
Anterior attachments of the middle pharyngeal constrictor muscle are the greater horn of the hyoid bone and the inferior portion of the stylohyoid ligament
The posterior attachment is the pharyngeal raphe
*the inferior part of the middle pharyngeal constrictor muscle lies deep to the inferior pharyngeal constrictor muscle
What separates the inferior and the middle pharyngeal constrictor muscle
The superior laryngeal nerve- internal laryngeal branch
Superior pharyngeal constrictor muscle
Anterior attachment is the pterygomandibular raphe and its posterior attachments are the pharyngeal raphe and pharyngeal tubercle of the occipital bone
*the inferior part of the superior pharyngeal constrictor muscle lies deep to the middle pharyngeal constrictor muscle
Border between the middle and superior pharyngeal constrictor muscle
Stylopharyngeus muscle
What attaches the superior edge of the superior pharyngeal constrictor muscle to the base of the skull
The pharyngobasilar fascia- dense connective tissue
The stylopharyngeus muscle
Attached to the medial surface of the styloid process superiorly and to the inner aspect of the pharyngeal wall inferiorly. It enters the wall by passing between the superior and middle pharyngeal constrictor muscles.
Can be palpated 1/2 inch above the greater horn of the hyoid bone
What crosses the posterior and lateral surfaces of the stylopharyngeus muscle to enter the pharynx
Glossopharyngeal nerve- CN IX
The most inferior fibers of the inferior constrictor muscle are continuous with the circular fibers of
The esophagus
The pharyngeal plexus is located at the posterolateral aspect of the pharynx and receives branches from:
Glossopharyngeal nerve- sensory to the pharyngeal mucosa
Vagus nerve- motor to the pharyngeal constrictor muscle
Superior cervical sympathetic ganglion- vasomotor
Glossopharyngeal nerve tract out of jugular foramen
Passes between the internal and external carotid arteries as it approaches the stlyopharyngeus muscle
Vagus nerve tract out of the jugular foramen
Branches
Lies posterior to the internal carotid artery and internal jugular vein in the carotid sheath.
Superior laryngeal nerve arises from the vagus 2.5cm inferior to the base of the skull- internal and external branch to the larynx
The pharyngeal branch of the vagus nerve arises near the base of the skull to the pharyngeal plexus
Accessory nerve tract out of jugular foramen
Passes between internal jugular vein and the internal carotid artery to reach the deep surface of the SCM
The hypoglossal nerve passes
Lateral to the internal and external carotid arteries
Superior cervical sympathetic ganglion and trunk lie
Posterior and medial to the carotid sheath
Cartilages that compose the laryngeal skeleton
Epiglottic, cricoid, thyroid, arytenoid
Corniculate and cuneiform
Posterior cricoarytenoid muscles
Proximal attachment is the lateral margin and the posterior lamina of the cricoid cartilage
Distal attachments are the muscular processes of the arytenoid cartilages
Abducts the vocal folds to open the rima glottidis
Arytenoid muscle
Attaches both arytenoid cartilages and has transverse and oblique fibers
Adducts the vocal folds to close the rima glottidis
The recurrent laryngeal passes
Posterior to the cricothyroid joint
At this point the nerve becomes the inferior laryngeal nerve
Cricothyroid muscle and vocalis muscle function
Tightens the vocal folds
Thyroarytenoid, transverse arytenoid and lateral cricoarytenoid muscle function
Adducts vocal fold to close the rima glottidis
What is the only extrinsic laryngeal muscle
Cricothyroid muscle
The larynx has 3 spaces/cavities
The vestibule, ventricle, and infraglottic cavity
The vestibule is the space superior to the vestibular folds
False vocal folds
True vocal folds
Space between the true vocal folds
Vestibular folds- lie superolateral to the vocal folds (true folds)
Rima glottidis
Conus elasticus
Lateral cricothyroid ligament
The thickened upper margin of the conus elasticus forms the vocal ligament
The aryepiglottic folds
Bound the upper border of the laryngeal inlet
Quadrangular membrane under its mucosa- the membrane extends from the lateral border of the epiglottis cartilage to the arytenoid cartilage and that it becomes thickened inferiorly to help form the vestibular folds
The cricothyroid joint
Synovial joint reinforced by short ligaments
The recurrent laryngeal enters the larynx by passing posterior to the cricothyroid joint, and at this point it becomes the inferior laryngeal nerve
Sensory innervation to the mucosa that lines the interior of the larynx below and including the vocal folds
Recurrent laryngeal nerve
Mucosa above the vocal folds is supplied by
The internal branch of the superior laryngeal nerve
Find what nerve along the lateral border of the thyrohyoid membrane
Internal branch of the superior laryngeal nerve and the superior laryngeal nerve
What supplies the cricothyroid muscle
External branch of superior laryngeal nerve
Superior laryngeal artery origin
Superior thyroid artery
Enters the larynx by penetrating the thyrohyoid membrane alongside the internal branch of the superior laryngeal nerve
The superior 1/3 of the nasal mucosa
The remainder of the nasal mucosa
Is olfactory in nature
Is respiratory in nature
Separates the right and left nasal cavities and forms the anterior part of the nasal septum
The septal cartilage
The lateral nasal cartilage is an extension of the septal cartilage
Lateral to the septal cartilage
Alar cartilage- gives shape to the nostril
The lumen of the pharynx communicates anteriorly with 3 cavities
Nasal, oral, and larynx.
Parts of the pharynx: nasopharynx, oropharynx, laryngopharynx.
The nasopharynx lies
The transition region form the nasal cavity to the nasopharynx is the
Posterior to the nose and superior to the soft palate
Posterior nasal aperture (Choana). The choana of the two sides are separated by the posterior end of the nasal septum
On the lateral wall of the nasopharynx- opening of the
Pharyngotympanic tube (auditory, Eustachian tube)
Superior to the opening of the pharyngotympanic tube is the:
What extends from it
Torus tubarius- the cartilage of the pharyngotympanic tube that is covered by mucosa
The salpingopharyngeal fold extends posteroinferiorly from the torus tubarius
Superior and posterior to the torus tubarius is
The pharyngeal recess.
The pharyngeal tonsil (adenoid) is located in the mucous membrane above the pharyngeal recess
The oropharynx is bound by
What forms a dividing line between the oral cavity and the oropharynx
What connects this dividing line
Superiorly the soft palate and extends inferiorly to the level of the epiglottis
The palatoglossal fold- extends from the tongue to the palate.
The transitional region between the right and left palatoglossal folds is called the fauces
What fold is posterior to the palatoglossal fold
What is between them
Palatopharyngeal fold- descends along the lateral wall of the oropharynx
The palantine tonsil is between them
The laryngopharynx extends
Posterior to the larynx
Extends from the hyoid bone to the lower border of the cricoid cartilage
In the midline of the laryngopharynx
Then the space farther inferiorly and laterally is the
Epiglottis and the laryngeal inlet (aditus)
Piriform recess, which is lateral to the midline. Borders of the piriform recess are the larynx medially, thyroid cartilage laterally, and inferior pharyngeal constrictor muscle posteriorly.
In the clinic: adenoids
Enlarged pharyngeal tonsils
Obstruct the flow of air from the nose through the nasopharynx, making mouth breathing necessary.
Boundaries of the nasal cavity
Roof- a narrow region bounded by the nasal septum and by the nasal bone, cribiform plate of ethmoid bone, and sphenoid bone.
Floor- palatine process of the maxilla and horizontal plate of the palatine bone
Medial- nasal septum
Lateral wall- maxilla, lacrimal bone, ethmoidal bone, inferior nasal concha, and perpendicular plate of palatine
Embedded in the mucosa of the nasal septum
Nasopalatine nerve (V2) and sphenopalatine artery Pass diagonally down the septum from the sphenopalatine foramen to the incisive canal. They supply the nasal septum and a portion of the oral mucosa that covers that hard palate
Mucosa near the cribiform plate is the
Olfactory area- extends down the lateral wall of the nasal cavity for a short distance
Supplies by anterior ethmoidal nerve- V1
Lateral wall of the nasal cavity structures
Sphenoethmoidal recess- above the superior concha
Superior concha
Superior meatus- inferior to the superior concha
Middle concha
Middle meatus- inferior to the middle concha
Inferior concha
Inferior meatus- inferior to the inferior concha
Vestibule- the area superior to the nostril and anterior to the inferior meatus
Atrium- the area superior to the vestibule and anterior to middle meatus
Underneath the anterior 2/3 of the inferior concha
Opening of the nasolacrimal duct
Underneath the anterior 2/3 of the middle concha in the middle meatus
The semilunar hiatus
Posterior to the curvature of the semilunar hiatus is the ethmoidal bulla
Within the semilunar hiatus
Opening of the frontal sinus
Opening of the anterior ethmoidal cells
Opening of the maxillary sinus
Opening of the middle ethmoidal cells are
Opening of the posterior ethmoidal cells are
On the summit of the ethmoidal bulla
In the superior meatus
The opening of the sphenoidal sinus
In the sphenoethmoidal recess
The sphenoidal sinus lies directly inferior to the hypophyseal fossa and pituitary gland
The ethmoidal cells are located between the
Nasal cavity and the orbit
The roof of the maxillary sinus is the:
The floor of the sinus is the:
The opening of the sinus
The roots of the maxillary teeth
Floor of the orbit and the infraorbital nerve innervates the mucosa of the maxillary sinus
Alveolar process of the maxilla
Is near its roof
Project into the sinus
In the clinic: sphenoidal sinus
Surgical approaches to the pituitary gland take advantage of the fact that the sphenoidal sinus and nasal cavity provide a direct approach
In the clinic: maxillary sinus
When the head is in an upright position, the maxillary sinus cannot drain. If infections of the maxillary sinus persist, an opening was sometimes made surgically through the inferior meatus near the floor of the sinus to promote drainage- low efficacy
When the roots of the maxillary teeth project into the sinus, they are covered only by mucosa. During extraction of a maxillary molar or premolar tooth, the mucosa superior to the projecting root may be torn and a fistula may be formed between the oral cavity and the maxillary sinus
Oral vestibule
Oral cavity proper
Bounded externally by the lips and cheeks and internally by the teeth and gums
The area between the alveolar arches and teeth. The largest content of this cavity is the tongue.
Parts of the tongue
Root- posterior 1/3
Body- anterior 2/3
Apex
Dorsum- entire extent of tongue
Terminal sulcus- divides anterior from posterior thirds
Lingual tonsil- posterior to the terminal sulcus
Foramen cecum- in the midline at the point of the terminal sulcus
Median sulcus
Lingual papillae- vallate, filliform, fungiform, foliate
Root of the tongue structures
Median glossoepiglottic fold- a midline fold of mucosa between the dorsum and epiglottis
Lateral glossoepiglottic fold- between the dorsum of the tongue and the lateral border of the epiglottis
Epiglottic vallecula- a depression between median and lateral glossoepiglottic folds
Geniohyoid muscle
Deep to the mylohyoid.
Anterior attachment is the inferior mental spine of the mandible
Posterior attachment is the body of the hyoid
Pulls the hyoid bone anteriorly
Genioglossus muscle
Anterior attachment is the superior mental spine of the mandible and its posterior attachment is the tongue
Protrudes the tongue
Innervated by the hypoglossal nerve
The sublingual mucosa on the mandible- immediately deep to this is the
Sublingual gland- Rests on the mylohyoid muscle
Along the medial side of the sublingual gland is the submandibular duct where it opens anteriorly on the sublingual caruncle and posteriorly to the deep part of the submandibular gland (deep to the mylohyoid)
The lingual nerve in the sublingual region
Beings lateral to the submandibular duct, crosses it inferiorly and goes into the the tongue medial to the duct. Supplies the mucosa of the anterior 2/3 of the tongue with general sensation and taste fibers
Near the third mandibular molar tooth is the
Submandibular ganglion that is suspended below the lingual nerve
The hypoglossal nerve in the sublingual region
Passes between the submandibular gland and the hypoglossus muscle
*both the hypoglossal and the lingual nerve pass between the hypoglossus and mylohyoid muscle to enter the sublingual region. The hypoglossal nerve course is inferior to the lingual’s.
Innervates the intrinsic muscles of the tongue and 3 extrinsic muscles of the tongue- styloglpossus, genioglossus, and hypoglossus.
Hypoglossus muscle
Deep to the mylohyoid muscle
Inferior attachment are the body and greater horn of the hyoid
Superior attachment is the lateral side of the tongue
Depresses and retracts the tongue
Styloglossus muscle
Near the superior end of the hypoglossus muscle
Proximal attachment is the styloid process and its distal attachment is the lateral side of the tongue.
Retracts the tongue and draws it superiorly
The lingual artery passes medial to the hypoglossus muscle and is renamed
The deep lingual artery
In the clinic: hypoglossal nerve
Genioglossus protrudes the tongue
If one genioglossus muscle does not function, the tongue cannot be protruded midline. The functional side of the tongue protrudes normally and the side with the dysfunctional nerve is protruded less or not at all. The protruded tongue deviates toward the side of the nerve lesion
Palatoglossus muscle
Proximal attachment is the palatine aponeurosis
Distal attachment- side of the tongue
Elevates posterior part of tongue and draws the soft palate onto the tongue
Innervated by CN X
The pterygopalatine fossa
Small boney space located medial to the infratemporal fossa and lateral to the wall of the nasal cavity
Accessed from the infratemporal fossa through the pterygomaxillary fissure
The pterygopalatine fossa contains
Pterygopalatine ganglion- receives its preganglionic afferents, which traveled via CN VII, the greater petrosal nerve, and the nerve of the pterygoid canal, and supplies every exocrine gland in the head except saliva and sweat glands.
The pterygopalatine fossa is a major crossroad for
Terminal branches of the maxillary artery and branches of the maxillary division of the trigeminal nerve
Branches of the sphenopalatine artery
Posterior lateral nasal artery- to the lateral nasal wall
Posterior septal artery- to the nasal septum
Greater palatine canal contents
Greater palatine nerve, lesser palatine nerve, and descending palatine artery (one of the terminal branches of the maxillary artery)
At the inferior end of the canal, the descending palatine artery divides to give rise to the greater palatine artery and lesser palatine artery
Where the lesser and greater palatine nerve converge superiorly
Inferior extent of the pterygopalatine ganglion- location for the synapse for the preganglionic axons of the facial nerve that course first in the greater petrosal nerve and then in the nerve of the pterygoid canal (Vidian nerve)
Postganglionic fibers that arise from the ganglion distribute with the branches of the maxillary division of the trigeminal nerve.
This ganglion stimulates secretion from the mucosa of the nasal cavity, paranasal sinuses, nasopharynx, roof of mouths and soft palate, and stimulates the lacrimal gland.
The nerve of the pterygoid canal
Vidian nerve
Enters the pterygopalatine fossa from posteriorly
Contains preganglionic parasympathetic axons from the greater petrosal and postganglionic sympathetic axons from the deep petrosal nerve
Maxillary artery in the pterygomaxillary fissure
Sphenopalatine artery- passes through the pterygopalatine fossa and then through the sphenopalatine foramen to enter the nasal cavity
Descending palatine artery- enters the greater palatine canal and splits into the greater and lesser palatine arteries
Infraorbital artery- passes through the inferior orbital fissure to enter the infraorbital canal and emerge on the face at the infraorbital foramen
CN V2
Courses from the foramen rotundum to the inferior orbital fissure, passes through the pterygopalatine fossa and gives off pterygopalatine branches that will form the greater and lesser palatine nerves
Deep to the mucosa covering the palatopharyngeal fold are
Delicate fibers of the palatopharyngeus muscle
Superior attachments are the hard palate and palatine aponeurosis
Inferior attachment are the thyroid cartilage and pharyngeal wall
Elevates the larynx during swallowing
Deep to the mucosa of the salpingopharyngeal fold are
The delicate fibers of the salpingopharyngeus muscle
Superior attachment is the cartilage of the pharyngotympanic tube. It’s distal attachments and action are the same as the palatopharyngeus muscle, with which it blends. (Thyroid cartilage and pharyngeal wall/elevates the larynx)
These two muscles contribute to the inner longitudinal muscle layer of the pharynx
The gap between the superior border of the superior pharyngeal constrictor muscle and the base of the skull is closed by the
Pharyngobasilar fascia
Passing through this gap are the pharyngotympanic tube and the levator veil palatine muscle
Levator veli palatini muscle
Superior attachments are the cartilage of the pharyngotympanic tube and the adjacent part of the temporal bone
It’s distal attachment is the palatine aponeurosis
Elevates the soft palate during swallowing and yawning
Tensor veli palatini muscle
Lies lateral to the medial plate of the pterygoid process just anterior to the levator veli palatini muscle
Superior attachment is the scaphoid fossa
The belly of the muscle is between the medial and lateral plates of the pterygoid process. It’s tendon turns medially around the harmful us of the medial pterygoid plate and forms the palatine aponeurosis.
Tenses the soft palate and opens the mouth of the pharyngotympanic tube during swallowing and yawning
Five muscles of the soft palate and pharynx are innervated by the
Vagus nerve via the pharyngeal plexus- salpingopharyngeus, levator veli palatini, palatoglossus, palatopharyngeus, and musculoskeletal uvulae.
The tensor veli palatini is innervated by V3.
The nasopalatine nerve
Descending through the incisive foramen from the nasal septum to supply the sensory innervation to the mucosa over the anterior part of the hard palate beyond the sensory field of the greater palatine nerve
Boundaries of the tonsilar bed
Anterior- palatoglossal fold
Posterior- palatopharyngeal fold
Lateral- superior pharyngeal constrictor muscle
Deep to the mucosa covering the palatoglossal fold
Delicate fibers of the palatoglossus muscle
Superior attachment is the palatine aponeurosis and its inferior attachment is the lateral side of the tongue.
Elevates tongue and depresses the soft palate
What nerve passes between the superior and middle pharyngeal constrictor muscles to enter the tonsillar bed
Glossopharyngeal nerve- innervates the mucosa of posterior 1/3 of tongue and posterior wall of the pharynx
Musculus uvulae muscle
Proximal attachment is the posterior nasal spine and palatine aponeurosis
Distal attachment is the mucosa of the uvula
Shortens the uvula and pulls it superiorly
